Maximizing Third Party Reimbursement:
Looking Ahead to ICD-10
Prepared By: Stacey L. Murphy, MPA, RHIA, CPC
AHIMA Approved ICD-10-CM/ICD-10-CM Trainer
Exam Prep Facilitator
This material was produced as an informational reference for
•HealthHIV.
Click to
Master text
styles
Noedit
representation,
warranty,
or guarantee that
compilation
of this
information is error-free and we bear no
– Second
level
responsibility or liability for the results or consequences of the
o Third level
use of this material. Although every reasonable effort has
– Fourth
level the accuracy of the information within
been made
to assure
» Fifth
level
this presentation,
the
information is constantly changing and
it is the responsibility of the individual to remain abreast of
each health plans regulatory requirements since regulations,
policies and/or guidelines cited in this presentation are
subject to change without further notice.
2
• Click to edit Master
text styles
– History
of ICD Code
– Second level
o Third level
– Fourth level
» Fifth level
Changes
– Overview of Changes
– Impact of Changes
– ICD-9 Phase Out
– ICD-10 Readiness
– Next Steps
3
– ADA: American Diabetes Association
•– Click
to edit Master text styles
AMA: American Medical Association
– Second
– CMS:
Centers forlevel
Medicare and Medicaid Services
o ThirdProcedural
level
– CPT: Current
Terminology
– Fourth level
– HCPCS: Healthcare
Common Procedure Coding System
» Fifth
level
– HHS: Health and
Human
Services
– HIPAA: Health Insurance Portability and Accountability Act
– ICD-9-CM: International Classification of Diseases, 9th Revision Clinical
Modification
– ICD-10-CM: International Classification of Diseases, 10th Revision
Clinical Modification
– ICD-10-PCS: International Classification of Diseases, 10th Procedure
Coding System
4
– LIDOS: Line Item Date of Service
•– Click
to edit Master text styles
MITA: Medicaid Information Technology Architecture
– Second
– MMIS:
Medicaid level
Management Information Systems
Third
levelclassified
– NEC: o
Not
elsewhere
– Fourth
levelfor Healthcare Statistics
– NCHS: National
Center
» Fifthspecified
level
– NOS: Not otherwise
– PAMA: Protecting Access to Medicare Act
– ProFee: Professional (Physician Services) Claim
– RTP: Returned to Provider
– WHO: World Health Organization
5
• Click to edit Master text styles
ICD-9-CM:
– Second level
th
– International
Classification
of
Diseases
9
o Third level
Revision,
Clinical
Modification
– Fourth
level
» Fifth level
– Developed
by WHO in1948
– Revised and published for use in the U.S. in
1979
– Used for morbidity and mortality statistics
– Describes medical conditions (diseases),
injuries and poisoning
–• CMS
the usetext
of ICD-9
Clickmandated
to edit Master
stylescodes on all
claims
sincelevel
October 1988
– Second
– CMS
revised
o Third
level these mandates to reflect
“mandatory”
– Fourth level correct reporting of ICD-9
Fifth
codes »on
alllevel
claims
– ICD-9 no longer reflects emerging technology
• Click to edit Master text styles
ICD-10
– Second
levelICD-10 in 1994
– WHO
adopted
o Third level
– Undergone many revisions leading to its
– Fourth level
implementation
in the U.S. dating back to 1995
» Fifth level
– Federal regulations mandate the use of codes
on all HIPAA electronic transactions
– Standard medical data code set designated by
HIPAA
– Codes used for data collection, reimbursement
purposes and to determine resource allocation in
the U.S
–• ICD-10
only
supported
version
Click to
edit
Masterby
text
styles5010
electronic health care transaction standards
– Second level
mandated by HIPAA
o Third level
– Version
4010
used through 2003
– Fourth
level
» Fifth level required all HIPAA
– 2009 regulations
"covered entities“ to begin using Version
5010 since January 1, 2012
– Discretionary grace period granted by
CMS through June 30, 2012
Version
5010
• Click to
edit Master text styles
– Administrative
transactions such as: patient
– Second level
eligibility
claim submissions,
o Thirdverification,
level
remittance
advices
(EOB’s)
– Fourth
level
» Fifth level
– Information
sent/received from health insurance
plans or clearinghouses
– All covered entities must change from
version 4010 to version 5010
– EXCEPTIONS: State workmen’s compensation
carriers, long/short term disability carriers and no
fault carriers
–• Version
5010
transaction
standards
Click to
edit
Master text
styles allows
covered entities to submit administrative
– Second level
transactions such as:
o Third level
– Check
patient
eligibility
– Fourth
level
– Submit claims
» Fifth level
– Check claims status
– Coordination of benefits
– Send/receive remittance advices (EOB’s)
– Diagnosis and procedure code information
– Health plan claims adjudication
• Click to edit Master text styles
ICD-10-CM:
– Second level
– International
Classification
of
Diseases
o Third level
10th Revision,
Clinical Modification
– Fourth level
» Fifth level
– Used to report medical diagnoses by
all health care provider types
– Very similar to ICD-9
• Click to edit Master text styles
ICD-10-PCS:
– Second level
– International
Classification of Diseases 10th
o ThirdProcedure
level
Revision
Coding System
– Fourth level
– Used to »report
procedures/services performed on
Fifth level
patients designated as inpatient hospital status
– Describes the facility (institutional) service; not the
professional (physician) service
– Developed by 3M Health Information Systems
under contract with CMS
– Brand new coding system and new format
Click to edit
textusing
stylesCPT and
–• Physicians
willMaster
continue
– Second
level
HCPCS
regardless
of setting
o Third
level
– CPT
published
and maintained by the AMA
– Fourth level
–Codes
describe
medical procedures and
» Fifth
level
physician services
– HCPCS established and maintained by CMS
–Codes describe non-physician services,
supplies, and other services not located in
CPT code book
Click responsible
to edit Master
styles
–• NCHS
for text
all ICD-9-CM,
– Second1 level
volumes
& 2 (ICD-10-CM) code
o Third level
changes
– Fourth level
– CMS responsible
» Fifth level for all ICD-9-CM volume
3 (ICD-10-PCS) code changes
– New codes approved annually every
October 1st
– Revised codes approved annually every
April 1st
Timeline
August 2008
Very first ICD-10 implementation date proposed October 1, 2011
January 16,
2009
ICD-10 implementation date final ruling October 1, 2013 and adoption of version 5010 transaction standards
• Click to edit Master text styles
Partial code freeze oflevel
ICD-9-CM codes
– Second
October 1, 2011
June 30, 2012
o
Third level
Discretionary grace period granted by CMS; no enforcements/penalty during this time
August 24, 2012
HHS issued final rule; ICD-10 delayed from October 1, 2013 to October 1, 2014
January 1, 2012
January 1, 2013
Implementation date for version 5010 transaction standards for all HIPAA covered entities; excluding small health plans
– Fourth level
»date
Fifth
level
Implementation
for version
5010 transaction standards for small health plans ONLY
October 1, 2012
Limited code updates to ICD-9-CM and ICD-10 code sets to capture new technology and diseases as required by section
503(a) of Public Law 108-173
October 1, 2013
Limited code updates to ICD-10 code sets
April 1, 2014
The Protecting Access to Medicare Act of 2014 (PAMA); Public Law 113-93 prevented the Secretary of HHS from
implementing ICD-10 on October 1, 2014
July 31, 2014
HHS issued final rule: ICD-10 delayed from October 1, 2014 to October 1, 2015
October 1, 2014
Limited code updates to ICD-10 code sets
October 1, 2015
ICD-10 implementation in the U.S.
October 1, 2016
Regular code updates to ICD-10 will begin
New/revised
terminology
Click to edit
Master text styles
New/revised coding guidelines
– Second level
Increase in number of available codes
o Third level
Increased use of specificity
– Fourth level
Increased use
oflevel
laterality
» Fifth
Increased use of combination codes
Limited use of NEC and NOS
ICD-10-CM comprises of 21 chapters vs 17 chapters in
ICD-9-CM
– Eponyms not used in ICD-10-PCS
– Room for future code expansion
–•
–
–
–
–
–
–
–
What Has Changed?
Certain infectious and parasitic diseases (A00-B99)
• Click
to edit Master text styles
Chapter 1
Chapter 2
Neoplasms (C00-D49)
Chapter 3
o
Third the
level
involving
immune mechanism (D50-D89)
– Second
level
Diseases of the blood and blood-forming organs and certain disorders
Chapter 5
– Fourth
level and metabolic diseases (E00-E89)
Endocrine,
nutritional
» Fifth level
Mental, Behavioral
and Neurodevelopmental disorders (F01-F99)
Chapter 6
Diseases of the nervous system (G00-G99)
Chapter 7
Diseases of the eye and adnexa (H00-H59) – NEW SECTION
Chapter 8
Diseases of the ear and mastoid process (H60-H95) – NEW SECTION
Chapter 9
Diseases of the circulatory system (I00-I99)
Chapter 10
Diseases of the respiratory system (J00-J99)
Chapter 11
Diseases of the digestive system (K00-K95)
Chapter 4
18
What Has Changed?
• Click to edit Master text styles
Chapter 12 Diseases of the skin and subcutaneous tissue (L00-L99)
Chapter 13 Diseases of the musculoskeletal system and connective tissue (M00-M99)
– Second level
Chapter 14 Diseases of the genitourinary system (N00-N99)
o Third childbirth
level and the puerperium (O00-O9A)
Chapter 15 Pregnancy,
– conditions
Fourth level
Chapter 16 Certain
originating in the perinatal period (P00-P96)
Chapter 17
Fifth level deformations and chromosomal abnormalities (Q00Congenital»malformations,
Q99)
Chapter 18
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere
classified (R00-R99)
Chapter 19 Injury, poisoning and certain other consequences of external causes (S00-T88)
Chapter 20 External causes of morbidity (V00-Y99) – NEW SECTION
Chapter 21
Factors influencing health status and contact with health services (Z00-Z99) – NEW
SECTION
19
• ClickExpansion
to edit Master text styles
Code
– Addition
– Second
oflevel
dummy placeholder “x” for certain
codes
to: level
o Third
– Fourthcharacters
level
– Fills empty
for codes that require 6th and
» Fifth level
7th character
designation to provide additional
details to for:
–
–
–
–
–
–
Inclusion of trimesters in Obstetrics
Diabetes (now reflects ADA classifications)
Substance abuse
Postoperative complications
Injuries (Gustillo fracture classification and concussions)
External causes of injuries
• Click
– When
to placeholder
edit Master text
character
styles applies,
belevel
used to ensure that code is
– must
Second
o Third level
valid
– Fourth level
– Designation
» Fifth levelof
EXCLUDES1 and
EXCLUDES2 notes
– Excludes1: Codes stated as Excludes1, never
reported with selected code
– Excludes2: Condition excluded is not part of the
condition represented by the selected code
Diagnosis: ICD-9-CM vs. ICD-10-CM
CODES text styles
•ICD-9-CM
Click DIAGNOSIS
to edit Master
ICD-10-CM CODES
Volumes (1 & 2)
– Second level
Approximately 13,000 codes
o Third level
Approximately 70,000 codes
3- 5 characters in length
Up to 7 characters in length
First character is alpha or numeric
(493.90, V20.2)
•
First character always alpha (except letter U)
•
Not case sensitive
(J45.x, Z00.121)
– Fourth level
» Fifth level
Characters 2-5 are always numeric
•
•
Second character always numeric
3-7 character alpha or numeric
Use of decimal point after 3rd character
Use of decimal point after 3rd character
Limited inclusion of co-morbidities, complications, severity,
manifestation, risks, sequelae or other disease related parameters
Inclusion of co-morbidities, complications, severity, manifestation,
risks, sequelae or other disease related parameters
No distinction of laterality (left/right/bilateral)
Includes laterality as appropriate
No distinction of initial or subsequent episodes
Includes initial vs. subsequent episodes as appropriate
Combination codes are limited
Includes numerous combination codes
Code expansion availability very limited
Use of dummy place holder “x” as applicable for future code
expansion
22
Diagnosis: ICD-9-CM vs. ICD-10-CM
ICD-9-CM
• Click to editbecomes
Master text ICD-10-CM
styles
ICD-9-CM
CODE STRUCTURE
– Second
level
xxx. o Third level
xx
Category
ICD-10-CM CODE STRUCTURE
xxx.
– Fourth level
Etiology,
» Fifth level
anatomic site and Category
manifestation
824.8 - Unspecified closed
fracture of ankle
One (1) ICD-9-CM code
xxx
Etiology, anatomic
site and
manifestation
x
Extension
(Encounter
type)
fracture S82.891A - Other fracture of right lower leg
(ANKLE), initial encounter for closed
S82.892A - Other fracture of left lower leg (ANKLE),
initial encounter for closed fracture
S82.899A - Other fracture of unspecified lower leg
(ANKLE), initial encounter for closed fracture
Forty-eight (48) ICD-10-CM
codes
11
AIDS/HIV Codes: ICD-9-CM vs. ICD-10-CM
• Click
to edit Master text styles
Description
Description
ICD-9-CM
Category/
Code
– Second level
ICD-10-CM
Category/
Code
HIV Disease
o
Third level
−AIDS
042
079.52
079.53
−AIDS
Syndrome
– Like
Fourth
level
−AIDS Related Complex
» Fifth level
(ARC)
−Symptomatic HIV Infection
−HIV 1
−Human T-cell lymphotrophic
virus, type II [HTLV-II]
HIV 2
−Report as secondary Dx
code only (when applicable)
B20
Human immunodeficiency
virus [HIV] disease
B97.34
Human T-cell lymphotrophic virus,
type II [HTLV-II] as the cause of
diseases classified elsewhere
B97.35
Human immunodeficiency virus,
type 2 [HIV 2] as the cause of
diseases classified elsewhere
24
AIDS/HIV Codes: ICD-9-CM vs. ICD-10-CM
• Click
to edit Master text styles
Description
Description
ICD-9-CM
Category/
Code
V73.89
–Special
Second
level
Screening for Other
Specified
Diseases
o ThirdViral
level
(HIV/AIDS)
– Fourth level
795.71
Fifth levelof HIV
Nonspecific» Evidence
−Inconclusive HIV Test
V08
Asymptomatic HIV status
−HIV+
−HIV + status
V65.44
HIV Counseling
ICD-10-CM
Category/
Code
Z11.59
Encounter for screening for
other viral diseases
R75
Inconclusive laboratory evidence
of human immunodeficiency
virus [HIV]
Z21
Asymptomatic human
immunodeficiency virus [HIV]
infection status
Z71.7
Human immunodeficiency virus
[HIV] counseling
25
Well Visits: ICD-9-CM vs. ICD-10-CM
• Click
to edit Master text styles
Description
Description
ICD-9-CM
Category/
Code
– Second level
ICD-10-CM
Category/
Code
Routine
infant,
child or
o Third
level
adolescent check up/exam; Ages
level
29 days–toFourth
– 17 years
old
Z00.121
Encounter for routine child health
examination with abnormal findings
Z00.129
Encounter for routine child health
examination without abnormal
findings
V20.31
Routine newborn check up/exam;
0 to 7 days old
Z00.110
Health examination for newborn
under 8 days old
V20.32
Routine newborn check up/exam;
8 days to 28 days old
Z00.111
Health examination for newborn 8 to
28 days old
Z00.00
Encounter for general adult medical
examination without abnormal
findings
Z00.01
Encounter for general adult medical
examination with abnormal findings
V20.2
» Fifth level
V70.0
Routine adolescent or adult check
up/exam; ages 18 years and
older
26
Immunizations: ICD-9-CM vs. ICD-10-CM
• Click to edit Master text
styles
ICD-10-CM
ICD-9-CM
Category/
Code
Description
– Second level
Category/
Code
Description
Need
for prophylactic
o Third
level
vaccination and
– Fourth level
inoculation against
» Fifthdiseases,
level viral
V03.0-V06.9 bacterial
diseases, single diseases
and combination of
diseases
ICD-9-CM
Examples
V04.81- Flu
V06.4 - MMR
V06.5 - Td
Encounter for
Z23
immunization
V06.1 - DTaP
V03.2 - Tuberculosis
There are 39 total ICD-9-CM vaccine codes that map to one (1) ICD-10-CM code
27
• Click to edit Master text styles
– Second level
o Third level
– Fourth level
» Fifth level
New coding system!!!
ICD-9-CM vs. ICD-10-PCS
ICD-9-CM
• ClickPROCEDURE
to edit CODES
Master
Volume (3)
– Second level
Approximately 4,000 codes
o Third level
3- 4 numeric digits in length
– Fourth level
Frequent use of NEC (not elsewhere specified)
andlevel
NOS (not otherwise
»
Fifth
specified)
Medical condition occasionally included in the code
text styles
ICD-10-PCS CODES
Approximately 87,000 codes
Up to 7 alpha-numeric characters in length
The term character is used instead of digit
Medical conditions not included in code
NEC and NOS not commonly used
No distinction of laterality (left/right/bilateral)
Includes laterality as appropriate
Generic terms for body parts
Detailed descriptions for body parts
Frequent use of eponyms (named after someone)
Eponyms are rarely used
General body locations
Frequent use of detailed body locations
Frequent use of combination codes
Combination codes are rarely used
Common medical terminology that does not reflect current technology
Complete new medical terminology to reflect current technology
Uses decimal points after 2nd character
No decimal points or other punctuations used
Limited space for new codes
Can accommodate new codes
• Click to edit Master text styles
– Second level
o Third level
– Fourth level
» Fifth level
ALL CODES MUST CONTAIN SEVEN (7) CHARACTERS!!!
–• Every
code
have
characters
Click to
editmust
Master
text7 styles
– Second
level represents an aspect of
– Each
character
o Third level
a procedure
– Fourth level
st
– The 1 character
represents the section
» Fifth level
– There are 16 sections in PCS
– Within each code, the 2nd through 7th
characters have a standard meaning
– Each character has a meaning or value
Potential
of ICD-10-PCS
• Click tonumber
edit Master
text styles values=34
– A–value
is one
of the 24 letters (out of 26) and
Second
level
10 numbers
that can be used to represent one
o Third level
of the 7– characters
in the code
Fourth level
» Fifth
level up of:
– Values are
made
– 10 numbers: 0–9
– 24 out of 26 letters: A–H, J–N, and P–Z
–The letters “O” and “I” not used
–Prevents confusion with digits “0” and “1”
–•Each
Clickvalue
to edit
has
Master
a specific
text styles
meaning
based
on its
location within the code
– Second
level
o Third
level
– May
have
different meanings across
– Fourth
level
sections
and
positions
» Fifth level
–Character 0=Medical and Surgical
Section in the 1st position for Section
–Character 0=Central Nervous System in
the 2nd position for Body System
• Click to edit Master text styles
– Second level
o Third level
– Fourth level
» Fifth level
• Click to edit Master text styles
– Second level
o Third level
– Fourth level
» Fifth level
•Laparoscopic
Click to edit Master
text styles
Cholecystectomy
– Second level
ICD-9-CM
o Third level
5
– Fourth level
» Fifth level
1
.
2
3
ICD-10-PCS
0
F
T
4
4
Z
Z
• Click to edit Master text styles
Documentation
– Second level
– Documentation
should clearly
o Third level
reflect
:
– Fourth level
– Laterality
» Fifth
(right,
level left, both/bilateral)
– For Diabetes care:
– Type I, Type II, other specified diabetes
– Drug/chemical induced
– Must specify drug/chemical that caused DM
condition
– Long term use of insulin (if applicable)
37
Documentation
For Eye
conditions:
• –Click
to edit Master
text
styles
–Retinopathy
– Second
level severity (mild, moderate,
severe)
o Third level
–Proliferative
– Fourth level vs. non-proliferative
» Fifth level
–The presence/absence
of macular
edema
–Blindness/low vision status (low vision,
unqualified visual loss, legally blind)
–WHO definition vs. USA definition
–Glaucoma staging (mild, moderate,
severe, indeterminant)
38
Additional
Documentation
Tips:
• Click to edit
Master text styles
– Asthma severity: use of measurement scale
– –Second
level
Intermittent,
mild persistent, moderate persistent,
persistent
osevere
Third level
– Glasgow
Coma
Scale: eye opening, verbal response,
– Fourth
level
motor response
» Fifth level
– For fractures and injuries:
– Fracture classification: Gustilo Open Fracture Types I,
II, IIIA, IIIB, IIIC
– Stage of care: initial, subsequent, sequela
– For well visits (adult, adolescent, children):
– With or without abnormal findings
– For pregnancy complications:
– Include trimester
39
Coding
• Click to edit Master text styles
– Coding
extremely
– Second
level important
– Drives
reimbursement
o Third
level
– Coders– must
analyze every page of
Fourth level
documentation
to ensure all codes are
» Fifth level
reported as appropriate
–
–
–
–
Insufficient documentation
Medical necessity errors
Code specific errors
Unsigned chart note errors
Unspecified coding will result in increased
denials; greatly impacts reimbursement
40
• Click to editCode
Master
text styles
ICD-9/ICD-10
Freeze
Timeline
– October
1, 2011:
final regular, updates were made
– Second
level
– October
1, 2012
o Third
level& October 1, 2013: limited code
updates–for
newlevel
technology and new diseases in
Fourth
accordance
withlevel
Section 503(a) of Public Law 108-173
» Fifth
– Affected ICD-9 & ICD-10 codes
– October 1, 2014: limited code updates to ICD-10
– No further updates made to ICD-9-CM since these
codes will no longer be used for reporting
– October 1, 2015: regular updates to ICD-10 will resume
ICD-9 Coding System will be phased out
• Click to edit Master text styles
October 1, 2015 and replaced with two new
– Second level
Codingo Third
Systems:
level ICD-10-CM & ICD-10-PCS
– All covered
entities
– Fourth
levelas defined by HIPAA must adopt
ICD-10
» Fifth level
– ICD-10 only supported by version 5010 electronic
health care transaction standards mandated by
HIPAA
– All covered entities must change from version 4010
to version 5010
– EXCEPTIONS: State workmen’s compensation,
long/short term disability, no fault carriers
claims
be
handled
•How
Clickshould
to edit Master
text
styles
that
spanlevel
October 1, 2015?
– Second
(i.e. span
o Third date:
level September 29, 2015October
3, 2015)
– Fourth
level
» Fifth
level rendered to patients that
– Claims for
services
extend beyond midnight on September 30,
2015, separate into two LIDOS claims as
follows:
– One claim for all services through September
30, 2015 with ICD-9-CM codes
– One claim for all services on or after October
1, 2015 with ICD-10-CM codes
–
Ambulatory
surgery
• Observation
Click to editcare,
Master
text styles
services,
ERlevel
services and ProFee services
– Second
– Outpatient
o Third level hospital split claim and use
FROM
date
– Fourth
level
» Fifth
level
– Inpatient
hospital
(institutional) services
submitted based on DISCHARGE date
– Discharged September 2015, report ICD-9-CM
codes
– Discharged October 2015, report ICD-10-CM
code and ICD-PCS codes
• Clickwill
to happen
edit Master
text styles
What
to claims
that contain
ICD-9-CM
– Secondcodes
level for services on or after
o Third1,
level
October
2015?
Fourth level
– Claims– that
contain ICD-9-CM codes for
» Fifth level
services will be handled as follows:
– Direct data entry institutional claims: RTP
– Paper professional and supplier claims:
Returned as unprocessable
– Electronic institutional, professional, and
supplier claims: Rejected
–• Continue
ICD-9-CM
codes
through
Click toreporting
edit Master
text
styles
September 30, 2015
– Second level
– Claims submitted with ICD-10 codes for services rendered
o Third
level
through
September
30, 2015 will be denied
– Fourth level
– Begin reporting
ICD-10-CM codes on October 1, 2015
» Fifth level
– Claims submitted with ICD-9-CM codes for services rendered
on or after October 1, 2015 will be denied
– These changes do not affect coding procedures/
services for ProFee billing
– Continue reporting CPT and HCPCS codes
– ICD-10-CM implementation date October 1, 2015:
5 months away
• Click to edit Master
text styles
Comprehensive
analysis
of your
– Second level
practice
should include a high
o Third level
level look
– Fourthat:
level
» Fifth level
 People
 Processes
 Technology
Step
1: Readiness
• Click
to editassessment
Master text styles
Step 2: Identify internal implementation team
– Second level
Step 3: Budget and resource allocation
o Third level
Step 4: Identify
processes and systems that use coding
– Fourth level
Step 5: Identify
stafflevel
that require training/create training
» Fifth
plan
Step 6: Test your systems and processes
Step 7: Assess vendor and payer readiness
Step 8: Monitor/continuous monitoring of your processes,
systems, vendors and payers
–• Perform
initial
assessment
of your practice
Click toanedit
Master
text styles
– Develop
thelevel
overall project and get
– Second
preliminary
approval
o Third level
Fourth level
– Identify– areas/business
units impacted by this
change » Fifth level
– Provide communication to executive levels
and to the organization as a whole
– Set realistic timelines to ensure that you are on
schedule
– Identify issues early and propose resolutions
–• Develop
project
plan;text
get approval
Click toaedit
Master
styles
– Set
up a regular
– Second
level reporting system so that the
progress
each step can be tracked
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––All
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Second
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Next Steps?
•
•
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•
•TheClick
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transition toto
ICD-10
is required
for everyone covered
the Health Insurance Portability
Accountability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT coding
for outpatient procedures and physician services.
Road to 10: CMS Online Tool for Small Practices
Jumpstart your ICD-10 transition with Road to 10, an online resource built with input from
providers in small practices.
“Road to 10” includes specialty references and helps providers build ICD-10 action plans
–practice
Fourthneeds.
level
tailored for their
CMS Resources
» Fifth
Check out the updated
CMSlevel
ICD-10 Resources Flyer
Access new Medscape Education resources that provide guidance around the transition to
ICD-10. Continuing medical education (CME) and nursing continuing education (CE) credits
are available to health care professionals who complete the learning modules. Anyone
can earn a certificate of completion. If you are a first-time visitor to Medscape, you will
need to create a free account to access these resources
– Video: ICD-10: Getting From Here to There -- Navigating the Road Ahead
– Video: ICD-10 and Clinical Documentation
– Expert Column: Preparing for ICD-10: Now Is the Time
View the ICD-10 Introduction fact sheet
Find official resources designed to help providers, payers, vendors, and non-covered entities
with the transition to ICD-10
Stay up to date on ICD-10!
Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter
– Second level
o Third level
• Click to edit Master text styles
– Second level
o Third level
– Fourth level
» Fifth level
– Centers for Medicare and Medicaid Services (CMS) –
• http://cms.gov/Medicare/Coding/ICD10/index.html
Click to edit Master text styles
– Second level
– American Medical Association (AMA) –
o Third level
http://www.ama-assn.org/
– Fourth level
– The American»Academy
Fifth levelof Family Physicians (AAFP)
http://www.aafp.org/practice-management/payment/coding/icd10countdown.html
– National Center for Health Statistics (NCHS)
http://www.cdc.gov/nchs/icd/data/CDC_ICD10_Transition_FactSheet_12_2013.pdf
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Web Resources
– Centers for Disease Control (CDC)
• Click
to edit Master text styles
http://www.cdc.gov/nchs/icd/icd10.htm
–
– Second level
American Academy of Professional Coders (AAPC)
o Third level
https://www.aapc.com/icd-10/
– Fourth level
– American Health Information Management Association (AHIMA)
» Fifth level
http://www.ahima.org/topics/icd10
–
American Hospital Association (AHA)
http://www.aha.org/advocacy-issues/medicare/ipps/coding.shtml
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Other Resources
• Click to edit Master text styles
– Second level
– ICD-10-PCS
2015. Publisher: Ingenix Optum.
o Third level
– Fourth level
» Fifth level
Note: Coding resources are updated annually. Please be sure to update coding resources
each year.
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